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Al-Droubi SS, Jahangir E, Kochendorfer KM, Krive M, Laufer-Perl M, Gilon D, Okwuosa TM, Gans CP, Arnold JH, Bhaskar ST, Yasin HA, Krive J. Artificial intelligence modelling to assess the risk of cardiovascular disease in oncology patients. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2023; 4:302-315. [PMID: 37538144 PMCID: PMC10393891 DOI: 10.1093/ehjdh/ztad031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 04/11/2023] [Accepted: 05/04/2023] [Indexed: 08/05/2023]
Abstract
Aims There are no comprehensive machine learning (ML) tools used by oncologists to assist with risk identification and referrals to cardio-oncology. This study applies ML algorithms to identify oncology patients at risk for cardiovascular disease for referrals to cardio-oncology and to generate risk scores to support quality of care. Methods and results De-identified patient data were obtained from Vanderbilt University Medical Center. Patients with breast, kidney, and B-cell lymphoma cancers were targeted. Additionally, the study included patients who received immunotherapy drugs for treatment of melanoma, lung cancer, or kidney cancer. Random forest (RF) and artificial neural network (ANN) ML models were applied to analyse each cohort: A total of 20 023 records were analysed (breast cancer, 6299; B-cell lymphoma, 9227; kidney cancer, 2047; and immunotherapy for three covered cancers, 2450). Data were divided randomly into training (80%) and test (20%) data sets. Random forest and ANN performed over 90% for accuracy and area under the curve (AUC). All ANN models performed better than RF models and produced accurate referrals. Conclusion Predictive models are ready for translation into oncology practice to identify and care for patients who are at risk of cardiovascular disease. The models are being integrated with electronic health record application as a report of patients who should be referred to cardio-oncology for monitoring and/or tailored treatments. Models operationally support cardio-oncology practice. Limited validation identified 86% of the lymphoma and 58% of the kidney cancer patients with major risk for cardiotoxicity who were not referred to cardio-oncology.
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Affiliation(s)
- Samer S Al-Droubi
- Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN 37232, USA
- Department of Health Informatics at Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, 3200 South University Drive, Fort Lauderdale, FL 33328-2018, USA
| | - Eiman Jahangir
- Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN 37232, USA
| | - Karl M Kochendorfer
- University of Illinois at Chicago, 1919 West Taylor Street (MC 530), Chicago, IL 60612, USA
| | - Marianna Krive
- Advocate Aurora Healthcare, Advocate Heart Institute, 1875 Dempster Street, Suite 555 Park Ridge, IL 60068, USA
| | - Michal Laufer-Perl
- Sourasky Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Israel, Weizmann St 6, Tel Aviv-Yafo
| | - Dan Gilon
- Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Ein-Kerem, Jerusalem, 9112001, Israel
| | - Tochukwu M Okwuosa
- Rush University Medical Center, Department of Internal Medicine, 1725 W Harrison St., Suite 1010-A, Chicago, IL 60612, USA
| | - Christopher P Gans
- Department of Cardiovascular Medicine at Briarwood Health Associates, University of Michigan Health, 25 Briarwood Cir, Ann Arbor, MI 48108, USA
| | - Joshua H Arnold
- University of Illinois at Chicago, 1919 West Taylor Street (MC 530), Chicago, IL 60612, USA
| | - Shakthi T Bhaskar
- Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN 37232, USA
| | - Hesham A Yasin
- Department of Internal Medicine, Tennova Healthcare, 651 Dunlop Ln, Clarksville, TN 37040, USA
| | - Jacob Krive
- Corresponding author. Tel: (+1) 847-769-2846,
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Cardio-oncology: Understanding the different mechanisms of cardiovascular toxicity. Rev Port Cardiol 2022; 41:587-597. [DOI: 10.1016/j.repc.2021.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 03/03/2021] [Accepted: 04/15/2021] [Indexed: 11/19/2022] Open
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Lage R, Cebro-Márquez M, Rodríguez-Mañero M, González-Juanatey JR, Moscoso I. Omentin protects H9c2 cells against docetaxel cardiotoxicity. PLoS One 2019; 14:e0212782. [PMID: 30794687 PMCID: PMC6386316 DOI: 10.1371/journal.pone.0212782] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 02/08/2019] [Indexed: 11/19/2022] Open
Abstract
Background Association between obesity and cardiovascular diseases is well known, however increased susceptibility of obese patients to develop several cancer types is not so commonly known. Current data suggest that poorer overall survival in cancer patients might be associated to non-cancer-related causes such as higher risk of cardiotoxicity in obese patients treated with chemotherapeutic agents. Omentin, a novel adipokine decreased in obesity, is actually in the spotlight due to its favourable effects on inflammation, glucose homeostasis and cardiovascular diseases. Also, recent data showed that in vitro anthracycline-induced cardiomyocyte apoptosis is counteracted by omentin suggesting its cardioprotective role. Objective Our aim was to evaluate omentin effects against docetaxel toxicity. Results Our data indicate that omentin inhibits docetaxel-induced viability loss and that increased viability is associated to decreased caspase-3 expression and cell death. Although omentin reduces NOX4 expression, it failed to reduce docetaxel-induced reactive oxygen species production. Our results indicate that omentin decreases docetaxel-induced endoplasmic reticulum stress, suggesting that cardioprotective role might be associated to ERS inhibition. Conclusion These data suggest that omentin treatment may contribute to decrease susceptibility to DTX-induced cardiotoxicity.
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Affiliation(s)
- Ricardo Lage
- Cardiology Group, Center for Research in Molecular Medicine and Chronic Diseases (CIMUS), Universidade de Santiago de Compostela and Health Research Institute, University Clinical Hospital of Santiago de Compostela—Santiago de Compostela, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- * E-mail: (RL); (IM)
| | - María Cebro-Márquez
- Cardiology Group, Center for Research in Molecular Medicine and Chronic Diseases (CIMUS), Universidade de Santiago de Compostela and Health Research Institute, University Clinical Hospital of Santiago de Compostela—Santiago de Compostela, Spain
| | - Moisés Rodríguez-Mañero
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Department of Cardiology and Coronary Unit, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - José Ramón González-Juanatey
- Cardiology Group, Center for Research in Molecular Medicine and Chronic Diseases (CIMUS), Universidade de Santiago de Compostela and Health Research Institute, University Clinical Hospital of Santiago de Compostela—Santiago de Compostela, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Department of Cardiology and Coronary Unit, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Isabel Moscoso
- Cardiology Group, Center for Research in Molecular Medicine and Chronic Diseases (CIMUS), Universidade de Santiago de Compostela and Health Research Institute, University Clinical Hospital of Santiago de Compostela—Santiago de Compostela, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- * E-mail: (RL); (IM)
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Odynets T, Briskin Y. Effect of individualised physical rehabilitation programmes on the functional state of the cardiovascular system in women with post-mastectomy syndrome. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2019. [DOI: 10.12968/ijtr.2018.0003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/Aims The purpose of this study was to determine the effectiveness of individualised physical rehabilitation programmes aimed at improving cardiovascular function in women with post-mastectomy syndrome. Methods The following methods were applied: theoretical analysis of scientific and methodologic literature data, impedance cardiography, and mathematical statistical methods. A total of 115 women with late symptoms of post-mastectomy syndrome who completed the interventions were included in this study. The participants were randomly enrolled into three groups for the first individualised programme (Group 1, n=45), for the second individualised programme (Group 2, n=40) and for the third individualised programme (Group 3, n=30). The first programme included aqua aerobics (aqua jogging, aqua building, aqua stretching), conditional swimming and recreational aerobics; the second programme included conditional swimming and Pilates exercises; the third programme included yoga-based exercises and stretching. The study was conducted during the ambulatory rehabilitation stage and lasted for 12 months. Results It was found that most of the investigated hemodynamic parameters in all groups steadily improved during the year of rehabilitation. The average values of stroke volume, cardiac output, left ventricular work, left ventricular power after 12 months of rehabilitation were statistically better (P<0.05) in the first main group compared with the second and third main groups. Conclusions Individualised programmes of physical rehabilitation were effective in improvement of cardiovascular function of all studied patients with post-mastectomy syndrome.
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Affiliation(s)
- Tetiana Odynets
- Assistant Professor, Department of Theory of Sport and Physical Culture, Lviv State University of Physical Culture, Lviv, Ukraine; Department of Physical Rehabilitation, Khortytsia National Academy, Zaporizhzhia, Ukraine
| | - Yuriy Briskin
- Professor, Department of Theory of Sport and Physical Culture, Lviv State University of Physical Culture, Lviv, Ukraine
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Antolín S, Acea B, Albaina L, Concha Á, Santiago P, García-Caballero T, Mosquera JJ, Varela JR, Soler R, Calvo L. Primary systemic therapy in HER2-positive operable breast cancer using trastuzumab and chemotherapy: efficacy data, cardiotoxicity and long-term follow-up in 142 patients diagnosed from 2005 to 2016 at a single institution. BREAST CANCER (DOVE MEDICAL PRESS) 2018; 11:29-42. [PMID: 30643452 PMCID: PMC6311333 DOI: 10.2147/bctt.s179750] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the efficacy, cardiotoxicity profile and long-term benefits of neoadjuvant therapy in human epidermal growth factor receptor 2-positive operable breast cancer patients. PATIENTS AND METHODS A total of 142 patients diagnosed from 2005 to 2016 were included in the study. The treatment consisted of a sequential regimen of taxanes and anthracyclines plus trastuzumab. The clinical and pathological responses were evaluated and correlated with clinical and biological factors. The cardiotoxicity profile and long-term benefits were analyzed. RESULTS The median age was 49 years, and 4%, 69% and 27% of patients had stage I, II and III breast cancer, respectively, while 10% had inflammatory breast cancer at diagnosis. Hormone receptor (HR) status was negative in 43%, and 62% had grade III breast cancer. The clinical complete response rate was 49% and 63% as assessed using ultrasound and magnetic resonance imaging, respectively, and this allowed a high rate of conservative surgery (66%). The pathological complete response (pCR) rate was 52%, and it was higher in HR-negative (64%) patients than in HR-positive (41%) patients and in grade III breast cancer (53%) patients than in grade I-II breast cancer (45%) patients. Patients who achieved pCR had longer disease-free survival and a trend toward improved overall survival. A total of 2% of patients showed a 10% decrease in left ventricular ejection fraction to <50% during treatment. All patients except one recovered after discontinuation of trastuzumab. CONCLUSION A sequential regimen of taxanes and anthracyclines plus trastuzumab was effective, with high pCR rates and long-term benefit, and had a very good cardiotoxicity profile.
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Affiliation(s)
- Silvia Antolín
- Medical Oncology Department, Breast Unit, A Coruña University Hospital, A Coruña, Spain,
| | - Benigno Acea
- Surgery Department, Breast Unit, A Coruña University Hospital, A Coruña, Spain
| | - Luis Albaina
- Surgery Department, Breast Unit, A Coruña University Hospital, A Coruña, Spain
| | - Ángel Concha
- Anatomic Pathology Department, Breast Unit, A Coruña University Hospital, A Coruña, Spain
| | - Paz Santiago
- Anatomic Pathology Department, Breast Unit, A Coruña University Hospital, A Coruña, Spain
| | - Tomás García-Caballero
- Department of Morphological Sciences, University of Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - Joaquín J Mosquera
- Radiology Department, Breast Unit, A Coruña University Hospital, A Coruña, Spain
| | - José Ramón Varela
- Radiology Department, Breast Unit, A Coruña University Hospital, A Coruña, Spain
| | - Rafaela Soler
- Radiology Department, Breast Unit, A Coruña University Hospital, A Coruña, Spain
| | - Lourdes Calvo
- Medical Oncology Department, Breast Unit, A Coruña University Hospital, A Coruña, Spain,
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Muehlberg F, Funk S, Zange L, von Knobelsdorff-Brenkenhoff F, Blaszczyk E, Schulz A, Ghani S, Reichardt A, Reichardt P, Schulz-Menger J. Native myocardial T1 time can predict development of subsequent anthracycline-induced cardiomyopathy. ESC Heart Fail 2018; 5:620-629. [PMID: 29673122 PMCID: PMC6073029 DOI: 10.1002/ehf2.12277] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 01/19/2018] [Accepted: 01/30/2018] [Indexed: 02/06/2023] Open
Abstract
Aims This study aims to assess subclinical changes in functional and morphological myocardial magnetic resonance parameters very early into an anthracycline treatment, which may predict subsequent development of anthracycline‐induced cardiomyopathy (aCMP). Methods and results Thirty sarcoma patients with planned anthracycline‐based chemotherapy (360–400 mg/m2 doxorubicin‐equivalent) were recruited. Median treatment time was 19.1 ± 2.1 weeks. Enrolled individuals received three cardiovascular magnetic resonance studies (before treatment, 48 h after first anthracycline treatment, and upon completion of treatment). Native T1 mapping (modified Look–Locker inversion recovery 5s(3s)3s), T2 mapping, and extracellular volume maps were acquired in addition to a conventional cardiovascular magnetic resonance with steady‐state free precession cine imaging at 1.5 T. Patients were given 0.2 mmol/kg gadoteridol for extracellular volume quantification and late gadolinium enhancement imaging. Development of relevant aCMP was defined as drop of left ventricular ejection fraction (LVEF) by >10%. For analysis, 23 complete data sets were available. Nine patients developed aCMP with LVEF reduction >10% until end of chemotherapy. Baseline LVEF was not different between patients with and without subsequent aCMP. When assessed 48 h after first dose of antracyclines, patients with subsequent aCMP had significantly lower native myocardial T1 times compared with before therapy (1002.0 ± 37.9 vs. 956.5 ± 29.2 ms, P < 0.01) than patients who did not develop aCMP (990.9 ± 56.4 vs. 978.4 ± 57.4 ms, P > 0.05). Patients with aCMP had decreased left ventricular mass upon completion of therapy (86.9 ± 24.5 vs. 81.1 ± 22.3 g; P = 0.02), while patients without aCMP did not show a change in left ventricular mass (81.8 ± 21.0 vs. 79.2 ± 18.1 g; P > 0.05). No patient developed new myocardial scars or compact myocardial fibrosis under chemotherapy. Conclusions Early decrease of T1 times 48 h after first treatment with anthracyclines can predict the development of subsequent aCMP after completion of chemotherapy.
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Affiliation(s)
- Fabian Muehlberg
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center - a joint cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Berlin, Germany.,Department of Cardiology and Nephrology, HELIOS Hospital Berlin-Buch, Berlin, Germany
| | - Stephanie Funk
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center - a joint cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Berlin, Germany.,Department of Cardiology and Nephrology, HELIOS Hospital Berlin-Buch, Berlin, Germany
| | - Leonora Zange
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center - a joint cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Berlin, Germany.,Department of Cardiology and Nephrology, HELIOS Hospital Berlin-Buch, Berlin, Germany
| | - Florian von Knobelsdorff-Brenkenhoff
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center - a joint cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Berlin, Germany.,Department of Cardiology and Nephrology, HELIOS Hospital Berlin-Buch, Berlin, Germany.,Clinic Agatharied, Department of Cardiology, Ludwig-Maximilian University of Munich, Hausham, Germany
| | - Edyta Blaszczyk
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center - a joint cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Berlin, Germany.,Department of Cardiology and Nephrology, HELIOS Hospital Berlin-Buch, Berlin, Germany
| | - Alexander Schulz
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center - a joint cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Berlin, Germany.,Department of Cardiology and Nephrology, HELIOS Hospital Berlin-Buch, Berlin, Germany
| | - Saeed Ghani
- Department for Interdisciplinary Oncology and Sarcoma Center, HELIOS Hospital Berlin-Buch, Berlin, Germany
| | - Annete Reichardt
- Department for Interdisciplinary Oncology and Sarcoma Center, HELIOS Hospital Berlin-Buch, Berlin, Germany
| | - Peter Reichardt
- Department for Interdisciplinary Oncology and Sarcoma Center, HELIOS Hospital Berlin-Buch, Berlin, Germany
| | - Jeanette Schulz-Menger
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center - a joint cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Berlin, Germany.,Department of Cardiology and Nephrology, HELIOS Hospital Berlin-Buch, Berlin, Germany
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Nowsheen S, Viscuse PV, O’Sullivan CC, Sandhu NP, Haddad TC, Blaes A, Klemp J, Nhola L, Herrmann J, Ruddy KJ. Incidence, Diagnosis, and Treatment of Cardiac Toxicity from Trastuzumab in Patients with Breast Cancer. CURRENT BREAST CANCER REPORTS 2017; 9:173-182. [PMID: 29225726 PMCID: PMC5718359 DOI: 10.1007/s12609-017-0249-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE OF REVIEW Treatment with trastuzumab is a cornerstone of human epidermal growth factor receptor 2 (HER2)-overexpressing breast cancer treatment, but carries an unfortunate risk of toxicity to the cardiovascular system. Here we review recent findings on trastuzumab-associated cardiotoxicity, focusing on its incidence, diagnosis, and treatment. RECENT FINDINGS Screening with multigated acquisition scan (MUGA) or echocardiogram (ECHO) is recommended to assess cardiac function prior to and during trastuzumab therapy. Because trastuzumab-induced cardiotoxicity is typically reversible, cessation of trastuzumab and/or administration of first line heart failure agents effectively restores cardiac function in most cases. Severe trastuzumab-induced cardiotoxicity is rare enough that the risk-benefit ratio still weighs in favor of its use in the vast majority of patients with HER2+ breast cancer. SUMMARY An improved understanding of the pathophysiology underlying trastuzumab-induced cardiotoxicity and the identification of patients at highest risk will allow us to continue to safely administer trastuzumab in patients with breast cancer.
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Affiliation(s)
- Somaira Nowsheen
- Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Medicine and the Mayo Clinic Medical Scientist Training Program
| | | | | | | | | | - Anne Blaes
- Department of Medicine, University of Minnesota
| | - Jennifer Klemp
- Division of Clinical Oncology, University of Kansas Medical Center
| | - Lara Nhola
- Division of Cardiology Research, Mayo Clinic
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